Provider Demographics
NPI:1689627515
Name:ZOLL, EDEN J (DO)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:J
Last Name:ZOLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4022
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-0222
Mailing Address - Country:US
Mailing Address - Phone:207-221-2355
Mailing Address - Fax:207-221-2356
Practice Address - Street 1:208 VAUGHAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3204
Practice Address - Country:US
Practice Address - Phone:207-221-2355
Practice Address - Fax:207-221-2356
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1715204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100376OtherANTHEM BLUE CROSS BLUE SH
ME100376OtherANTHEM BLUE CROSS BLUE SH
MEME0086Medicare ID - Type Unspecified